Activities of Daily Living

Dementia is characterized by a decline in performance in two areas: cognitive abilities and practical everyday skills. These impairments affect the quality of life of the affected person and place a significant burden on the healthcare system (Boccaccio et al., 2021; Jefferson et al., 2006).

Activities of daily living (ADLs) can be divided into basic and instrumental ADLs. Instrumental ADLs include more complex practical everyday skills, such as preparing meals and making phone calls (Lawton & Brody, 1969). However, as dementia progresses, basic everyday practical skills, such as independent eating and personal hygiene (e.g., brushing teeth), also decline (Katz, 1963).

To assess limitations in ADLs, external assessment methods are most commonly used (e.g., Alzheimer’s Disease Cooperative Study – Activities of Daily Living Scale by Galasko et al., 1997). Although external assessment methods are easy to use, they do not reflect the actual limitations in the performances of affected individuals. For example, such a lack of correspondence may occur because family members tend to overestimate the affected individuals’ performances (Davis et al., 2006). This error and other assessment errors can largely be avoided by using a performance test.

Performance tests are based on the “objective” performance of the person in question and are therefore independent of assessments by relatives or professional nursing staff. Performance tests can cover basic ADLs, instrumental ADLs, or both. Performance tests that tend to measure basic ADLs include the Erlangen Test of Activities of Daily Living (E-ADL test; Graessel et al. 2009), whereas the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM; Luttenberger et al., 2016) measures more instrumental ADLs.

Whereas the E-ADL test is best suited for moderate and severe dementia, the ETAM is used for mild dementia and mild cognitive impairment (MCI).

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Boccaccio, D. E., Cenzer, I., & Covinsky, K. E. (2021). Life satisfaction among older adults with impairment in activities of daily living. Age and Ageing, 50(6), 2047-2054.

Davis, L. L., Weaver, M., & Habermann, B. (2006). Differential attrition in a caregiver skill training trial. Research in Nursing & Health, 29(5), 498-506.

Galasko, D., Bennett, D., Sano, M., Ernesto, C., Thomas, R., Grundman, M., & Ferris, S. (1997). An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. Alzheimer Disease & Associated Disorders, 11, 33-39.

Graessel, E., Viegas, R., Stemmer, R., Küchly, B., Kornhuber, J., & Donath, C. (2009). The Erlangen Test of Activities of Daily Living: first results on reliability and validity of a short performance test to measure fundamental activities of daily living in dementia patients. International Psychogeriatrics, 21(1), 103-112.

Jefferson, A. L., Paul, R. H., Ozonoff, A. L., & Cohen, R. A. (2006). Evaluating elements of executive functioning as predictors of instrumental activities of daily living (IADLs). Archives of Clinical Neuropsychology, 21(4), 311-320.

Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. jama, 185(12), 914-919.

Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.

Luttenberger, K., Reppermund, S., Schmiedeberg-Sohn, A., Book, S., & Graessel, E. (2016). Validation of the Erlangen test of activities of daily living in persons with mild dementia or mild cognitive impairment (ETAM). BMC geriatrics, 16(1), 111.

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  1. no immediate (direct) costs are incurred by the person being tested (billing as a health insurance benefit by third parties, e.g., doctors, is possible) and
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Erlangen Test of Activities of Daily Living (E-ADL); Erlangen Test of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (E-TAM); Activities of Daily Living (ADL); Mild Cognitive Impairment (MCI)